Durrant Joseph, Lip Gregory Y H, Lane Deirdre A
University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham, B18 7QH, UK.
Expert Rev Cardiovasc Ther. 2013 Jan;11(1):77-90. doi: 10.1586/erc.12.161.
Atrial fibrillation (AF) increases the risk of stroke. This additional risk varies depending on the presence of various clinical risk factors. The contribution of some risk factors, for example vascular disease and female gender, has been disputed. Stroke risk stratification scores (RSS) incorporate these risk factors to identify patients at different levels of stroke risk. These RSS enable the targeting of oral anticoagulants (OAC) at high-risk patients, who stand to gain the most in terms of stroke risk reduction, and avoidance of their use in low-risk patients, in whom the harms of OAC (increased risk of bleeding) may outweigh their stroke prevention capabilities. Guidelines on the management of AF have used and adapted various RSS for this purpose, and have tailored their therapeutic recommendations around the different risk categories. Current guidelines advocate the use of the CHA₂DS₂-VASc RSS to assess stroke risk in AF patients, to identify truly low-risk patients (men and women aged <65 years with no risk factors) who may not require antithrombotic therapy, with consideration of OAC for all other patients. The recent development of novel OACs is changing the risk threshold at which it is acceptable to treat AF patients. However, consideration of OAC therapy for stroke prevention also requires assessment of the associated bleeding risk and incorporation of patients' preferences when making treatment decisions.
心房颤动（AF）会增加中风风险。这种额外风险因各种临床风险因素的存在而有所不同。一些风险因素的作用，如血管疾病和女性性别，一直存在争议。中风风险分层评分（RSS）纳入了这些风险因素，以识别处于不同中风风险水平的患者。这些RSS能够针对高危患者使用口服抗凝剂（OAC），这类患者在降低中风风险方面获益最大，同时避免在低危患者中使用OAC，因为OAC的危害（出血风险增加）可能超过其预防中风的能力。房颤管理指南为此使用并调整了各种RSS，并围绕不同风险类别制定了治疗建议。当前指南提倡使用CHA₂DS₂-VASc RSS来评估房颤患者的中风风险，以识别可能不需要抗栓治疗的真正低危患者（年龄<65岁且无风险因素的男性和女性），而其他所有患者则考虑使用OAC。新型OAC的近期发展正在改变治疗房颤患者可接受的风险阈值。然而，考虑使用OAC进行中风预防时，还需要评估相关出血风险，并在做出治疗决策时纳入患者的偏好。
